N.L. singled out for lack of funding for anti-smoking programs, drugs

The Canadian Press
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A person smokes a cigarette in downtown Ottawa on Sept. 29, 2009. — File photo by The Canadian Press

A move to take advantage of rare advances in lung cancer treatment is being undermined by slow action on the part of provinces to pay for testing to determine which patients will benefit from the drugs, a new report suggests.

The work, from the Cancer Advocacy Coalition of Canada, says all provinces should pay for the tests needed to figure out who should take the expensive drugs, described by the author of the report as a ray of light at the end of a tunnel.

The  new report says more Canadians who smoke might quit if they had insurance coverage for smoking cessation products.

Just don’t expect to get any funding in Newfoundland and Labrador.

This province and New Brunswick were singled out in the report saying neither have public funding for nicotine replacement products or smoking cessation drugs.

“This is a huge advance in a disease in which everybody admits we’ve had no good news ever,” said Dr. David Saltman, a medical oncologist with the B.C. Cancer Agency.

The drugs he referred to are erlotinib (sold as Tarceva), gefitinib (Iressa) and crizotinib (Xalkori).

The first two target lung cancers in which the patients have mutated forms of the EGFR gene and the latter has been shown to be effective against lung cancers where a mutated version of the ALK gene is present.

The gene mutations are seen in a small subset of lung cancer patients — more precisely, people with a type of non-small-cell lung cancer known as adenocarcinoma. Saltman said about 15 per cent of people with adenocarcinoma have the EGFR mutation and between two and seven per cent have the ALK mutation.

People who are responsive to the drugs are more likely to be younger, female, people who never smoked and of Asian heritage.

And some provinces use that type of general descriptive information to try to hone in on who should be tested for the mutations, Saltman said. But he noted the mutations don’t always hold to a type, saying he has had some older male patients who smoked who have one of the mutated genes.

“We can’t select who should have testing on the basis of their clinical characteristics. We have to select on the basis of their molecular characteristics. It’s just not an ethical thing to do,” Saltman said at a news conference called to release the coalition’s annual cancer care report card.

“We should be testing everyone (with adenocarcinoma),”

The combined cost of the tests can be in the range of $500 to $600 per person.

The drugs are not a cure. But they offer real gains in patients in whom they work, Saltman said, and save the health-care system money in doing so.

Response to the drugs among people with the mutations can be in the 60 to 80 per cent range, with progression-free survival approaching a year, Saltman said. With standard chemotherapy, between 15 and 20 per cent of adenocarcinoma respond, he said, and the average progression-free survival period is about three months.

“So these drugs are very effective, but if you can’t test for them, you can’t give the drug.”

He said some provinces — British Columbia, Alberta, and in some cases, Manitoba — are paying for the tests.

In other provinces, some testing is being done through research projects or with funding from the test makers. And in some places, Saltman said, the testing is not being done.

The testing issue was one of several the report card touched on. Another was the variability in the insurance coverage Canadians have for access to smoking cessation aids. The report suggested more Canadians who smoke might quit if they had better coverage for things like nicotine replacement products and smoking cessation drugs.

It suggested smokers in Atlantic Canada are particularly hard hit because a combination of factors: the prevalence of smoking there is higher than in other parts of the country and more people in the region have no drug insurance.

The report said it’s hard to understand why jurisdictions that fund the cost of medication to treat high blood pressure and high cholesterol wouldn’t pay for drugs that help people quit smoking.

Organizations: Cancer Advocacy Coalition of Canada, B.C. Cancer Agency.The

Geographic location: Newfoundland and Labrador.This, New Brunswick, British Columbia Alberta Manitoba Atlantic Canada

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Recent comments

  • Bhauguna Sanjay
    December 02, 2013 - 01:39

    smoking can harm to our body and soul. we shouldn't use drugs and alcohol, smoking we should avoid these bad habits. i am requesting to people of world save the environment.

  • non smoker
    July 19, 2013 - 09:07

    speaking of smoking, well the first thing our goverment should do is inforce the non smoking rules they have made,like not smoking within so many feet of a public building.if you go to a bingo hall you have 10-15 people standing in the entrance smoking you can hardly get your breath , most of the smoke comes back in the building,and their are other buildings where the same thing is happening i am sick of breathing in that horrible stuff,some one should listen and put a stop to it,whats the point of having non smoking laws if no one is going to enforce .its time the people running those bingo put a stop to this ,or are they afraid it might reduce their attendance,then of course it might bring more .so who is responsible wake up and inforce the rules so we can breath clean aid,its my right

  • Willi
    July 17, 2013 - 16:05

    Very very good idea , go for it .

  • david
    July 14, 2013 - 11:16

    The smartest thing the Newfoundland gov't ever did...or didn't do actually...is spend more money on such drivel. "Quit this and quit that" programs are an abject waste of the dollars spent, they are shamelessly hypocritical, and they cost a fortune. You either quit because you eventually decide to on your own, or ou don't. No TV ad makes any difference, because if they did, no one could possibly be enticed by cigarettes in any way other than as a form of expensive, slow suicide. You want people to quit smoking? Make it $75 a pack, and put the money into health care. You want people to quit using drugs? Legalize and tax the Sh!+ out of that too.

  • yo mama
    July 13, 2013 - 11:00

    Healthcare should not be free for those with self-inflicted illnesses. You make your bed, you lie in it.